Provider Demographics
NPI:1689865594
Name:STORCK, BRANDY N (MS CCC-SLP/L)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:N
Last Name:STORCK
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3724 COUNTY ROAD 318
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-9141
Mailing Address - Country:US
Mailing Address - Phone:573-651-4607
Mailing Address - Fax:573-651-4607
Practice Address - Street 1:3724 COUNTY ROAD 318
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-9141
Practice Address - Country:US
Practice Address - Phone:573-651-4607
Practice Address - Fax:573-651-4607
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003019825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist